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yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK548252_"><span class="title" itemprop="name">Gabapentin</span></h1><p class="fm-aai"><a href="#_NBK548252_pubdet_">Publication Details</a></p></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="Gabapentin.OVERVIEW"><h2 id="_Gabapentin_OVERVIEW_">OVERVIEW</h2><div id="Gabapentin.Introduction"><h3>Introduction</h3><p>Gabapentin is a unique anticonvulsant that is used as adjunctive therapy in management of epilepsy and for neuropathic pain syndromes. Therapy with gabapentin is not associated with serum aminotransferase elevations, but several cases of clinically apparent liver injury from gabapentin have been reported.</p></div><div id="Gabapentin.Background"><h3>Background</h3><p>Gabapentin (gab" a pen' tin) is a structural analogue of gamma-aminobutyric acid (GABA), but demonstrates little or no interaction with GABA receptors and does not appear to alter GABA uptake, synthesis or metabolism. While initially believed to act on the GABA-ergic neurotransmitter system, the actual mechanism of action of gabapentin as an anticonvulsant and agent for neuropathy is unknown. Gabapentin was approved for use in the United States in 1993 and is a widely used medication with more than 18 million prescriptions filled yearly. Current indications include add-on therapy for partial seizures which do not have adequate control with other anticonvulsants, and to reduce neuropathic pain from diabetic and postherpetic neuropathy. Gabapentin is available as capsules or tablets of 100, 300, 400, 600 and 800 mg and in oral solution for pediatric use generically and under the brand names Neurontin and Gabarone. The recommended initial dose for adults is 300 mg three times daily increasing as needed to a maximum dose of 1800 mg daily. The most common side effects of gabapentin are dose related and include dizziness, somnolence, tremor, ataxia, blurred vision, anxiety, and gastrointestinal upset or nausea. Rare, but potentially severe adverse events include hypersensitivity reactions such as angioneurotic edema, drug rash with eosinophilia with systemic manifestations (DRESS syndrome) and Stevens-Johnson syndrome.</p></div><div id="Gabapentin.Hepatotoxicity"><h3>Hepatotoxicity</h3><p>Limited data are available on the hepatotoxicity of gabapentin. In clinical trials in diabetic neuropathy and epilepsy, therapy with gabapentin was not associated with an increased frequency of serum aminotransferase elevations or liver toxicity. Rare individual case reports of liver injury from gabapentin have been published, although the causal relationship of gabapentin with the liver injury was not always clear. The latency to onset in these reports was 1 to 8 weeks and associated with cholestatic pattern of enzyme elevations. Fever and rash have been described but not autoantibody formation. Reported cases have been mild to moderate in severity and self-limited in course. In view of the wide-scale use of gabapentin, liver injury with symptoms or jaundice is clearly quite rare.</p><p>Likelihood score: C (probable cause of clinically apparent liver injury).</p></div><div id="Gabapentin.Mechanism_of_Injury"><h3>Mechanism of Injury</h3><p>The apparent absence or low rate of significant hepatotoxicity from gabapentin may be due to its minimal hepatic metabolism and rapid urinary excretion.</p></div><div id="Gabapentin.Outcome_and_Management"><h3>Outcome and Management</h3><p>The case reports of hepatic injury due to gabapentin were followed by complete recovery without evidence of residual or chronic injury. No cases of acute liver failure or chronic liver injury due to gabapentin have been described. There is no information about cross reactivity with other compounds having similar structure (pregabalin). In general, gabapentin is well tolerated in patients with hypersensitivity reactions to other anticonvulsants.</p><p>Drug Class: <a href="/books/n/livertox/Anticonvulsants/?report=reader">Anticonvulsants</a></p></div></div><div id="Gabapentin.PRODUCT_INFORMATION"><h2 id="_Gabapentin_PRODUCT_INFORMATION_">PRODUCT INFORMATION</h2><p>
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<b>REPRESENTATIVE TRADE NAMES</b>
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</p><p>Gabapentin – Generic, Neurontin®</p><p>
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<b>DRUG CLASS</b>
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</p><p>Anticonvulsants</p><p>
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<a href="https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Gabapentin" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">COMPLETE LABELING</a>
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</p><p>Product labeling at DailyMed, National Library of Medicine, NIH</p></div><div id="Gabapentin.CHEMICAL_FORMULA_AND_STRUCTUR"><h2 id="_Gabapentin_CHEMICAL_FORMULA_AND_STRUCTUR_">CHEMICAL FORMULA AND STRUCTURE</h2><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figGabapentinTc"><a href="/books/NBK548252/table/Gabapentin.Tc/?report=objectonly" target="object" title="Table" class="img_link icnblk_img figpopup" rid-figpopup="figGabapentinTc" rid-ob="figobGabapentinTc"><img class="small-thumb" src="/books/NBK548252/table/Gabapentin.Tc/?report=thumb" src-large="/books/NBK548252/table/Gabapentin.Tc/?report=previmg" alt="Image " /></a><div class="icnblk_cntnt"><h4 id="Gabapentin.Tc"><a href="/books/NBK548252/table/Gabapentin.Tc/?report=objectonly" target="object" rid-ob="figobGabapentinTc">Table</a></h4></div></div></div><div id="Gabapentin.ANNOTATED_BIBLIOGRAPHY"><h2 id="_Gabapentin_ANNOTATED_BIBLIOGRAPHY_">ANNOTATED BIBLIOGRAPHY</h2><p>References updated: 30 July 2020</p><ul class="first-line-outdent"><li><div class="bk_ref" id="Gabapentin.REF.zimmerman.1999">Zimmerman HJ. Anticonvulsants. In, Zimmerman, HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999: pp. 498-516.<div><i>(Expert review of anticonvulsants and liver injury published in 1999; gabapentin is not discussed).</i></div></div></li><li><div class="bk_ref" id="Gabapentin.REF.pirmohamed.2013">Pirmohamed M, Leeder SJ. Anticonvulsant agents. In, Kaplowitz N, DeLeve LD, eds. Drug-induced liver disease. 3rd ed. Amsterdam: Elsevier, 2013: pp 423-42.<div><i>(Review of anticonvulsant induced liver injury; gabapentin is not discussed).</i></div></div></li><li><div class="bk_ref" id="Gabapentin.REF.smith.2018">Smith MD, Metcalf CS, Wilcox KS. Pharmacology of the epilepsies. In, Brunton LL, Hilal-Dandan R, Knollman BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 13th ed. New York: McGraw-Hill, 2018, pp. 303-26.<div><i>(Textbook of pharmacology and therapeutics).</i></div></div></li><li><div class="bk_ref" id="Gabapentin.REF.gabapentin.1994.89">Gabapentin Chadwick D. <span><span class="ref-journal">Lancet. </span>1994;<span class="ref-vol">343</span>:89–91.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/7903783" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7903783</span></a>]<div>
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<i>(Review of the clinical uses of gabapentin largely as add-on to other anticonvulsants. Most common side effects were somnolence, dizziness, ataxia, fatigue, nystagmus, headache, tremor, diplopia, nausea and rhinitis. “No serious idiosyncratic reactions have been identified with gabapentin and, in particular, there is no evidence of hypersensitivity reactions…”).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.us_gabapentin_study_group.1994.67">US Gabapentin Study Group. The long-term safety and efficacy of gabapentin (Neurontin) as add-on therapy in drug-resistant partial epilepsy. <span><span class="ref-journal">Epilepsy Res. </span>1994;<span class="ref-vol">18</span>:67–73.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/8088258" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8088258</span></a>]<div>
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<i>(Systematic review; ALT elevations occur in 4% of children on phenytoin, 6% on valproate, 1% on carbamazepine, but none reported on tiagabine or gabapentin).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.hamer.1999.239">Hamer HM, Morris HH. Hypersensitivity syndrome to antiepileptic drugs: a review including new anticonvulsants. <span><span class="ref-journal">Cleve Clin J Med. </span>1999;<span class="ref-vol">66</span>:239–45.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10199060" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10199060</span></a>]<div>
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<i>(Clinical review of anticonvulsant hypersensitivity syndrome, which occurs in 1 to 5 per 10,000 users of aromatic anticonvulsants with higher risk in African Americans and affected siblings; liver involvement common, but most cases are anicteric; other manifestations include facial edema, lymphadenopathy, bone marrow aplasia, pseudolymphoma, thyroiditis, interstitial nephritis; not linked to gabapentin).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.hamer.1999.190">Hamer HM, Morris HH. Successful treatment with gabapentin in the presence of hypersensitivity syndrome to phenytoin and carbamazepine: a report of three cases. <span><span class="ref-journal">Seizure. </span>1999;<span class="ref-vol">8</span>:190–2.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10356381" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10356381</span></a>]<div>
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<i>(3 patients developed rash, fever, lymphadenopathy and eosinophilia 4-6 weeks after starting either phenytoin or carbamazepine [bilirubin 0.5-1.8 mg/dL, ALT 866-1402 U/L, Alk P 69-364 U/L], resolving after stopping and not recurring during gabapentin therapy).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.wong.2000.35">Wong ICK, Lhatto SD. Adverse reactions to new anticonvulsant drugs. <span><span class="ref-journal">Drug Safety. </span>2000;<span class="ref-vol">23</span>:35–56.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/10915031" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10915031</span></a>]<div>
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<i>(Review of side effects of new anticonvulsants: side effects of gabapentin are largely CNS related and include somnolence, dizziness, diplopia, ataxia, tremor and nausea, but no mention of liver toxicity and overdose was associated with lethargy only).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.ragucci.2001.103">Ragucci MV, Cohen JM. Gabapentin-induced hypersensitivity syndrome. <span><span class="ref-journal">Clin Neuropharmacol. </span>2001;<span class="ref-vol">24</span>:103–5.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11307046" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11307046</span></a>]<div>
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<i>(72 year old man developed confusion and fever 8 days after starting gabapentin; was then given levofloxacin and developed rash liver abnormalities 2 days later [bilirubin normal, GGT 296 U/L, Alk P 218 U/L], resolving 15 days after stopping gabapentin; case did not fulfill criteria for hypersensitivity syndrome and was complicated by use of levofloxacin).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.lassodelavega.2001.3460">Lasso-de-la-Vega MC, Zapater P, Such J, Pérez-Mateo M, Horga JF. Gabapentin-associated hepatotoxicity. <span><span class="ref-journal">Am J Gastroenterol. </span>2001;<span class="ref-vol">96</span>:3460–2.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/11774985" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11774985</span></a>]<div>
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<i>(60 year old man developed skin rash and eosinophilia 1 month after starting gabapentin and 1 day after starting ciprofloxacin; 1 week later was found to be jaundiced [bilirubin not given, ALT ~320 U/L, GGT ~1000 U/L], gabapentin was decreased in dose and stopped a week later and laboratory tests improved concurrently: ciprofloxacin might also have been responsible).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.hauben.2002.2156">Hauben M. Re: Lasso-de-la-Vega et al. Gabapentin as a probable cause of hepatotoxicity and eosinophilia. <span><span class="ref-journal">Am J Gastroenterol. </span>2002;<span class="ref-vol">97</span>:2156–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/12190207" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12190207</span></a>]<div>
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<i>(Letter from industry sponsor suggesting that hypersensitivity reaction in patient described by Lasso-de-la-Vega [2001] was more likely due to ciprofloxacin than gabapentin).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.bureau.2003.1169">Bureau C, Poirson H, Péron JM, Vinel JP. <span><span class="ref-journal">Gastroenterol Clin Biol. </span>2003;<span class="ref-vol">27</span>:1169–70.</span> [Gabapentine-induced acute hepatitis] French. [<a href="https://pubmed.ncbi.nlm.nih.gov/14770125" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14770125</span></a>]<div>
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<i>(Patient developed jaundice, fever and pain 2 months after starting gabapentin, had inflamed gallbladder and underwent cholecystectomy, but bilirubin continued to rise [bilirubin either 2.7 or 27 mg/dL, ALT 8 times ULN, Alk P 12 times ULN]; gabapentin was stopped, ultimate complete recovery in ~1 month; unclear whether gabapentin or gallstones were the cause).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.wilby.2005.1">Wilby J, Kainth A, Hawkins N, Epstein D, McIntosh H, McDaid C, Mason A, et al. Clinical effectiveness, tolerability and cost-effectiveness of newer drugs for epilepsy in adults: a systematic review and economic evaluation. <span><span class="ref-journal">Health Technol Assess. </span>2005;<span class="ref-vol">9</span>:1–157.</span> iii-iv. [<a href="https://pubmed.ncbi.nlm.nih.gov/15842952" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15842952</span></a>]<div>
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<i>(Extensive systematic review of anticonvulsant medications including assessment of serious, rare and long term adverse events; severe side effects are rare with gabapentin; no mention of hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.laroche.2007.133">LaRoche SM. A new look at the second-generation antiepileptic drugs: a decade of experience. <span><span class="ref-journal">Neurologist. </span>2007;<span class="ref-vol">13</span>:133–9.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/17495757" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17495757</span></a>]<div>
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<i>(Review of second generation anticonvulsants approved since 1994 including felbamate, gabapentin, lamotrigine, topiramate, tiagabine, levetiracetam, oxcarbazepine, zonisamide and pregabalin; serious side effects are rare and no mention of liver toxicity from gabapentin).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.himmerich.2007.93">Himmerich H, Nickel T, Dalal MA, Müller MB. <span><span class="ref-journal">Psychiatr Prax. </span>2007;<span class="ref-vol">34</span>:93–4.</span> [Gabapentin treatment in a female patient with panic disorder and adverse effects under carbamazepine during benzodiazepine withdrawal] German. [<a href="https://pubmed.ncbi.nlm.nih.gov/17124639" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17124639</span></a>]<div>
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<i>(70 year old woman with panic disorder and benzodiazepine dependence who developed liver test abnormalities on carbamazepine [ALT 103 U/L, GGT 309 U/L] tolerated long term therapy with gabapentin, which allowed withdrawal of benzodiazepines without recurrence of ALT elevations).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.chalasani.2008.1924">Chalasani N, Fontana RJ, Bonkovsky HL, Watkins PB, Davern T, Serrano J, Yang H, Rochon J., Drug Induced Liver Injury Network (DILIN). Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. <span><span class="ref-journal">Gastroenterology. </span>2008;<span class="ref-vol">135</span>:1924–34.</span> [<a href="/pmc/articles/PMC3654244/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3654244</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18955056" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18955056</span></a>]<div>
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<i>(Among 300 cases of drug induced liver disease in the US collected between 2004 and 2008, valproate accounted for 6, lamotrigine 5, phenytoin 5, gabapentin and topiramate 1 each but details not provided).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.bj_rnsson.2008.281">Björnsson E. Hepatotoxicity associated with antiepileptic drugs. <span><span class="ref-journal">Acta Neurol Scand. </span>2008;<span class="ref-vol">118</span>:281–90.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/18341684" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18341684</span></a>]<div>
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<i>(Review of all anticonvulsant induced liver injury; neither gabapentin nor pregabalin are discussed).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF18">Drugs for epilepsy. <span><span class="ref-journal">Treat Guidel Med Lett. </span>2013;<span class="ref-vol">11</span>:9–18.</span> Erratum in Treat Guidel Med Lett 2013; 11: 112. [<a href="https://pubmed.ncbi.nlm.nih.gov/23348233" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23348233</span></a>]<div>
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<i>(Concise review of drugs of choice for epilepsy; gabapentin is FDA approved as adjunctive therapy of partial seizures and adverse effects include somnolence, dizziness, ataxia, fatigue, and blurred vision; no mention of hepatotoxicity or ALT elevations).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.fuzier.2013.55">Fuzier R, Serres I, Guitton E, Lapeyre-Mestre M, Montastruc JL., French Network of Pharmacovigilance Centres. Adverse drug reactions to gabapentin and pregabalin: a review of the French pharmacovigilance database. <span><span class="ref-journal">Drug Saf. </span>2013;<span class="ref-vol">36</span>:55–62.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/23315296" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23315296</span></a>]<div>
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<i>(Among 725 spontaneous adverse event reports related to gabapentin made to the French Pharmacovigilance System between 1995 and 2009, liver ranked second to neuropsychiatric reactions in frequency [n=90, 12%], 37 of which were “hepatitis”, half of which were serious, 8 were “probable” or “likely” and one fatal, but no specific details given).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF20">Gabapentin and pregabalin: hepatic and haematological toxicity. <span><span class="ref-journal">Prescrire Int. </span>2014;<span class="ref-vol">23</span>(154):267.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/25954794" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25954794</span></a>]<div>
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<i>(Review of spontaneous reports of adverse events attributed to gabapentin from a French registry [Fuzier 2013] identified 90 cases of liver damage, gabapentin being the only suspect drug in 10 cases of "hepatitis", one of which was fatal).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.chalasani.2015.1340">Chalasani N, Bonkovsky HL, Fontana R, Lee W, Stolz A, Talwalkar J, Reddy KR, et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study. <span><span class="ref-journal">Gastroenterology. </span>2015;<span class="ref-vol">148</span>:1340–52.e7.</span> [<a href="/pmc/articles/PMC4446235/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4446235</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25754159" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25754159</span></a>]<div>
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<i>(Among 899 cases of drug induced liver injury enrolled in a US prospective study between 2004 and 2013, 40 cases [4.5%] were attributed to anticonvulsants, including 3 to gabapentin, the latency to onset being 3-6 weeks, with a mixed or cholestatic pattern of injury and a moderate, self-limited course).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.zaccara.2017.811">Zaccara G, Giovannelli F, Giorgi FS, Franco V, Gasparini S, Benedetto U. Tolerability of new antiepileptic drugs: a network meta-analysis. <span><span class="ref-journal">Eur J Clin Pharmacol. </span>2017;<span class="ref-vol">73</span>:811–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28378057" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28378057</span></a>]<div>
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<i>(Metanalysis of the comparative tolerability of 18 new anticonvulsant agents including gabapentin, found lowest rates of withdrawal for adverse events with levetiracetam, brivaracetam, and gabapentin with highest rates with eslicarbazepine, oxcarbazepine, lacosamide and topiramate).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF23">Drugs for epilepsy. <span><span class="ref-journal">Med Lett Drugs Ther. </span>2017;<span class="ref-vol">59</span>(1526):121–30.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/28746301" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28746301</span></a>]<div>
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<i>(Concise review of the drugs available for therapy of epilepsy lists gabapentin as a second line, alternative therapy of partial onset seizures and mentions common side effects of somnolence, dizziness, ataxia, fatigue, blurred vision and confusion, but does not mention ALT elevations or hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.vidaurre.2017.23">Vidaurre J, Gedela S, Yarosz S. Antiepileptic drugs and liver disease. <span><span class="ref-journal">Pediatr Neurol. </span>2017;<span class="ref-vol">77</span>:23–36.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29097018" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29097018</span></a>]<div>
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<i>(Summary of the hepatotoxicity of major anticonvulsant medications including gabapentin which has no hepatic metabolism, so specific recommendation for dose modification because of liver disease, a minimal potential for drug interactions and low association with hepatotoxicity).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF25">Nonopioid drugs for pain. <span><span class="ref-journal">Med Lett Drugs Ther. </span>2018;<span class="ref-vol">60</span>(1540):25–32.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/29422479" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29422479</span></a>]<div>
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<i>(Concise review of the mechanism of action, clinical efficacy, common side effects and costs of nonopioid drugs that are used for pain, mentions that gabapentin is approved for use in post-herpetic and diabetic neuropathy; no mention of hepatic adverse events).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.borrelli.2018.2318">Borrelli EP, Lee EY, Descoteaux AM, Kogut SJ, Caffrey AR. Stevens-Johnson syndrome and toxic epidermal necrolysis with antiepileptic drugs: An analysis of the US Food and Drug Administration Adverse Event Reporting System. <span><span class="ref-journal">Epilepsia. </span>2018;<span class="ref-vol">59</span>:2318–24.</span> [<a href="/pmc/articles/PMC6420776/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6420776</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30395352" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30395352</span></a>]<div>
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<i>(Review of adverse event reports to the FDA between 2014 and 2018 identified ~2.9 million reports, 1034 for SJS/TEN, the most common class of drugs being anticonvulsants with 17 of 34 having at least one report, those most frequently linked being lamotrigine [n=106], carbamazepine [22], levetiracetam [14], phenytoin [14], valproate [9], clonazepam [8], zonisamide [7], gabapentin [4] and pregabalin [4]; no mention of accompanying liver injury or whether attribution was as a single agent or one of several).</i>
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</div></div></li><li><div class="bk_ref" id="Gabapentin.REF.canopaniagua.2019.501">Cano-Paniagua A, Amariles P, Angulo N, Restrepo-Garay M. Epidemiology of drug-induced liver injury in a University Hospital from Colombia: Updated RUCAM being used for prospective causality assessment. <span><span class="ref-journal">Ann Hepatol. </span>2019;<span class="ref-vol">18</span>:501–7.</span> [<a href="https://pubmed.ncbi.nlm.nih.gov/31053545" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31053545</span></a>]<div>
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<i>(Among 286 patients with liver test abnormalities seen in a single hospital in Colombia over a 1 year period, 17 were diagnosed with drug induced liver injury, the most common cause being antituberculosis therapy [n=6] followed by anticonvulsants [n=3, 1 each due to phenytoin, gabapentin and valproate]).</i>
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</div></div></li></ul></div><div id="bk_toc_contnr"></div></div></div><div class="fm-sec"><h2 id="_NBK548252_pubdet_">Publication Details</h2><h3>Publication History</h3><p class="small">Last Update: <span itemprop="dateModified">July 30, 2020</span>.</p><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="https://www.niddk.nih.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Institute of Diabetes and Digestive and Kidney Diseases</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Gabapentin. [Updated 2020 Jul 30].<span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"><a href="/books/n/livertox/Futibatinib/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a></div><div class="small-screen-next"><a href="/books/n/livertox/GabapentinEnacarbil/?report=reader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div></article><article data-type="table-wrap" id="figobGabapentinTc"><div id="Gabapentin.Tc" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK548252/table/Gabapentin.Tc/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__Gabapentin.Tc_lrgtbl__"><table><thead><tr><th id="hd_h_Gabapentin.Tc_1_1_1_1" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">DRUG</th><th id="hd_h_Gabapentin.Tc_1_1_1_2" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">CAS REGISTRY NUMBER</th><th id="hd_h_Gabapentin.Tc_1_1_1_3" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MOLECULAR FORMULA</th><th id="hd_h_Gabapentin.Tc_1_1_1_4" scope="col" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">STRUCTURE</th></tr></thead><tbody><tr><td headers="hd_h_Gabapentin.Tc_1_1_1_1" scope="row" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Gabapentin</td><td headers="hd_h_Gabapentin.Tc_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135006562" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem">60142-96-3</a>
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</td><td headers="hd_h_Gabapentin.Tc_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">C9-H17-N-O2</td><td headers="hd_h_Gabapentin.Tc_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
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<a href="https://pubchem.ncbi.nlm.nih.gov/substance/135006562" title="View this structure in PubChem" class="img_link" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubchem"><img src="https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?t=l&sid=135006562" alt="image 135006562 in the ncbi pubchem database" /></a>
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